Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

Magda Aguiar, Amanda Farley, Lucy Hope, Adeela Amin, Pooja Shah, Semira Manaseki-Holland, Magda Aguiar, Amanda Farley, Lucy Hope, Adeela Amin, Pooja Shah, Semira Manaseki-Holland

Abstract

Introduction Birth-related perineal trauma (BPT) is a common consequence of vaginal births. When poorly managed, BPT can result in increased morbidity and mortality due to infections, haemorrhage, and incontinence. This review aims to collect data on rates of BPT in low- and middle-income countries (LMICs), through a systematic review and meta-analysis. Methods The following databases were searched: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACs), and the World Health Organization (WHO) regional databases, from 2004 to 2016. Cross-sectional data on the proportion of vaginal births that resulted in episiotomy, second degree tears or obstetric anal sphincter injuries (OASI) were extracted from studies carried out in LMICs by two independent reviewers. Estimates were meta-analysed using a random effects model; results were presented by type of BPT, parity, and mode of birth. Results Of the 1182 citations reviewed, 74 studies providing data on 334,054 births in 41 countries were included. Five studies reported outcomes of births in the community. In LMICs, the overall rates of BPT were 46% (95% CI 36-55%), 24% (95% CI 17-32%), and 1.4% (95% CI 1.2-1.7%) for episiotomies, second degree tears, and OASI, respectively. Studies were highly heterogeneous with respect to study design and population. The overall reporting quality was inadequate. Discussion Compared to high-income settings, episiotomy rates are high in LMIC medical facilities. There is an urgent need to improve reporting of BPT in LMICs particularly with regards to births taking in community settings.

Keywords: Birth-related perineal trauma; Episiotomy; LMICs; OASI; Systematic review.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection process
Fig. 2
Fig. 2
Forest plot showing results from meta-analysis of the frequency of episiotomy. NS parity not stated in the study
Fig. 3
Fig. 3
World map showing the frequency of episiotomy by country
Fig. 4
Fig. 4
Forest plot showing results from meta-analysis of the frequency of second degree trauma by parity. NS parity not stated in the study
Fig. 5
Fig. 5
Forest plot showing results from meta-analysis of the frequency of oasis by parity. NS – parity not stated in the study
Fig. 6
Fig. 6
World map showing the frequency of oasis by country
Fig. 7
Fig. 7
Quality assessement results

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Source: PubMed

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